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Download membership information - International Society for Cellular Therapy
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Laboratory Practices Committee Membership Application Please note that you must be a current ISCT member to apply for committee membership. Complete information about the ISCT and its membership benefits may be found on-line at www.celltherapysociety.org. 1. Name: CONTACT INFORMATION ________________________________________________________________________________________________ Last First □ PhD □ MSc □ BSc Initial Degrees: □ MD □ MT □ Other: _____________________________________ Institution: ________________________________________________________________________________________________ Address: ________________________________________________________________________________________________ ________________________________________________________________________________________________ City: _______________________ State: Telephone: ___________________________________________ Email: ____________________________________________________________________ 2. _______________ Zip: Fax: _____________ Country: _________________ _________________________________________ Gender: □ Male □ Female MEMBERSHIP INFORMATION Please indicate your area of interest as it relates to cellular therapy. ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ Are you active in other Cellular Therapy Professional Organization Committees (AABB, FACT) Yes or No (If Yes Please List)____ ___________________________________________________________________________________________________________________ Are you available for Monthly Teleconferences? Yes or No Optional : List any recent publications: ____________________________________________________________________________ ___________________________________________________________________________________________________________ ISCT Head Office 375 West 5th Avenue, Suite 201, Vancouver BC V5Y 1J6 Canada Ph.: 604-874-4366 Fax: 604-874-4378 Email: [email protected] LPC Additional Membership Questions 1. What is your primary role in the cell therapy lab? (select one only) Medical Director Director Manager Technologist Research (pre-clinical) Technologist – testing only Translational Development Quality Assurance / Regulatory Other: What are your three strongest areas of expertise? cell product processing cell product testing quality assurance (audits, etc) regulatory compliance and accreditation lab operations facility design implementation of new lab processes cGMPs for cell therapy clinical trial design implementation of clinical trials information systems solutions data management translation to clinical scale/grade regulatory submissions (e.g., IDE, IND etc) 2. How many years of experience in the field of cell therapy do you have? ________ 3. What type of facility do you work in? Academic hospital Academic research center Blood or tissue bank Industry Consultant Regulatory agency Accrediting agency Other: _________________________________________ 4. How many staff members are in your laboratory or group? _________ 5. How many patients are transplanted per year? ___________ 6. How many products do you manufacture per year? __________ 7. What types of products/processing is performed in your facility? How many per year? HPC, Marrow _____ HPC, Cord Blood _____ HPC, Apheresis _____ Leukocytes (DLI) _____ Other: MSCs, HPC, Apheresis for cardiac and other applications _____ Magnetic selection _____ Combination with device ____ Expansion _____ Activation _____ Gene therapy _____ Other: ____________________ Thank you for your application. Please submit your Application Form to: Federico Rodriguez [[email protected]] ISCT Head Office 375 West 5th Avenue, Suite 201, Vancouver BC V5Y 1J6 Canada Ph.: 604-874-4366 Fax: 604-874-4378 Email: [email protected]
